Since its inception in 1990, the Singapore National Eye Centre (SNEC) has gained international recognition for its top-notch patient care and worldclass research and training in ophthalmology. Despite its successes, the SNEC, which handles 300,000 outpatient visits, 27,000 surgeries and 8,000 laser procedures each year, is not about to rest on its laurels. It is now charting its next phase of growth, through active involvement in research and clinical trials to solve the most pressing clinical problems. In advancing ophthalmic science and service, the SNEC will continue to play a key role in training and education, and forge further professional collaboration through strategic links with local eye care and healthcare organisations as well as leading eye institutions around the world.
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Our Vision International Eminence in Ophthalmology
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Our Mission To lead in the overall development of ophthalmology by: Providing the highest quality cost-effective ophthalmic care Nurturing and renewing the necessary human resources Pursuing high-impact competitive research
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The logo resembles a human eye. Beneath this simplicity is a message of deeper significance. The eyeball, with linear horizontal lines, correlates to a globe, depicting SNEC’s global vision. The progressively linear horizontal lines symbolise the importance of the eye in distant vision and the resulting demand for high quality ophthalmic service. The ‘eyelids’ with tapered edges form an ‘S’ which represents the word ‘Singapore’. That this should encase a globe conveys SNEC’s mission to make Singapore a hub for ophthalmic excellence. The neatly tapered edges of the ‘eyelids’ convey a sense of precision, bespeaking the high technological expertise required in ophthalmology. Both the logo and its words appear in vibrant yet soothing colours of blue and grey – reflective of a fast-moving, progressive organisation.
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VISION TO REALITY The logo reflects SNEC’s pole position at the cutting-edge of ophthalmology in Singapore and worldwide. It complements SNEC’s corporate logo by using a matching shade of blue and echoing elements from the SNEC logo. The tagline Vision to Reality translates SNEC’s 25 years of remit, legacy and achievements, into a simple statement that resonates with the public and employees.
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Message from the Medical Director
Although 25 years might not seem like a long time, both Singapore and the state of our healthcare have undergone tremendous changes. In 1990, when the Singapore National Eye Centre (SNEC) was established, Singapore had a population of just over three million people and the economy was making a transition from manufacturing to knowledge-based industries. Cataract was the major cause of blindness then; there was a hint of an “epidemic of myopia” in our schoolchildren; and age-related macular degeneration (AMD) was known as “senile degeneration”, denoting an inevitable decline in vision with age. At the same time, the practice of ophthalmology was experiencing a revolution, enabled by technology. For example, eye doctors were beginning to switch from extracapsular cataract extraction (ECCE) to phacoemulsification, a method which gave better and more predictable clinical outcomes. We also saw the transition from inpatient surgeries to day surgeries, and the gradual replacement of general with local anaesthesia during these procedures. These changes provided the foundation for a stand-alone ambulatory eye centre, giving birth to the concept of SNEC. Undoubtedly, the establishment of SNEC as a specialty centre independent from the Singapore General Hospital (SGH) was one of the most profound changes for ophthalmology in Singapore, a change
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which accelerated many other changes in the practice of eye care. When Professor Arthur Lim, founding Medical Director of SNEC, first started out with a team of nine, there was considerable resistance as people felt uncomfortable leaving SGH, not knowing whether SNEC would even survive. Joining a new upstart away from the “mothership” of SGH was risky business! Shortly after, Professor Lim mooted the idea of having a research institute within SNEC, which led to the development of the new Singapore Eye Research Institute (SERI). To build a research institute within a new healthcare institution was an idea way ahead of its time. SNEC has never failed to take risks while carrying out its mission, with a longer-term goal of excellence in mind. In a sense, as a new Medical Officer in SNEC, I experienced this culture in 1996 when Professor Lim asked me to consider doing a PhD at Johns Hopkins University in the United States. At that time, I was hoping to undergo clinical training to become a full-fledged ophthalmologist, like my peers. To take several years off without pay at this stage seemed so uncertain and risky. Furthermore, it was frowned upon for Singapore doctors to engage in research, which was seen as a distraction from clinical care. In fact, when I applied to the Public Service Commission for support to carry out my studies, they asked, “Should you be seeing patients instead?”
Nonetheless, Professor Lim went out of his way to support me, obtaining permission from the Ministry of Health and the National University of Singapore, and finding funding from the Lee Foundation and the Singapore Eye Foundation. How times have changed. Today, at SNEC, we fully embrace our role as a major academic eye centre in Asia and globally, with a triple, integrated mission of clinical care, research and education. As part of delivering even better care to our patients, we encourage our younger residents to have training and experience in conducting research and to be part of our teaching faculty. SNEC now partners with Duke-NUS Graduate Medical School Singapore to train future clinician scientists. In Singapore, biomedical sciences is now recognised as the fourth pillar of our economy, alongside electronics, engineering and chemicals, and SNEC/SERI is part of this pillar. 25 years after SNEC was conceptualised, Singapore’s population has almost doubled and now stands to close to 5.5 million. We face new challenges in eye care, with an ageing population and the rise of chronic diseases such as AMD and diabetes. As SNEC celebrates its silver jubilee, I am confident that our pioneering and dedicated faculty and staff as well as our younger future leaders will rise to meet these new challenges and take calculated “risks” for the next 25 years, just as we have done over the last 25 years. Professor Wong Tien Yin Medical Director, SNEC
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Felicitations from around the world
“Under the exemplary leadership and vision of Professor Arthur Lim and his successors, SNEC has raised the research, education, and practice of ophthalmology in Singapore to world-class status.” Professor Robert J. Cionni President American Society of Cataract and Refractive Surgery
“The impact of SNEC is “SNEC’s tremendous progress immense through high was evident each time quality services, matching I visited the center and now, the best in the world, directly after 25 years of development, to those who came to you and SNEC has emerged as a indirectly through scores center of excellence in the of your alumni around the areas of clinical service, world; and your cutting edge teaching and research.” research.” Professor Wang Ning Li Director and Vice President Beijing Tongren Hospital
Professor Gullapalli N. Rao President Academia Ophthalmologica Internationalis
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“SNEC has grown to be a world leading Centre. It has certainly grown way beyond what one could have reasonably anticipated.”
“For 25 years, the Centre has made spectacular accomplishments from advanced eye care, pioneering ophthalmic research, to extensive education programmes making SNEC the role model in Ophthalmology regionally and internationally.”
Professor Hugh R. Taylor AC President International Council of Ophthalmology
“Your centre is without question one of Singapore’s brightest stars that shines across the world and of which the country is immensely proud.”
Professor Dennis Lam President Asia-Pacific Academy of Ophthalmology
“The growth and success of SNEC mirrors the amazing growth and success of your country. Like Singapore, SNEC’s influence in world ophthalmology is far greater than its size.”
Professor Sir Peng Tee Khaw Professor of Glaucoma and Ocular Healing, and Consultant Ophthalmic Surgeon Moorfields Eye Hospital
Professor Tatsuro Ishibashi President Japanese Ophthalmological Society
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Felicitations from around the world
“The growth and development of SNEC has been nothing less than meteoric; a commentary on the enlightened support it has received from the government and private sectors, and the enthusiasm, dedication, and inspiring commitment and innovation of its staff and leadership.”
“The international ophthalmology community has watched with respect as SNEC has grown and matured under Professor Arthur Lim’s guidance and now your own, from a handful of dedicated clinicians in 1990 to a team of hundreds of professionals with a long list of research and clinical achievements to your credit.”
Professor Alfred Sommer University Distinguished Service Professor Gilman Scholar, Dean Emeritus Johns Hopkins University
Professor William F. Mieler President The Association for Research in Vision and Ophthalmology
“In a very short time you have managed to become a world leader in clinical care and cutting edge research. Quite an accomplishment!”
“Now, Singapore means excellence for those of us working in the field of ophthalmology and eye research.”
Professor Edward G. Buckley Vice-Dean for Education, Duke School of Medicine Chairman, Department of Ophthalmology Duke Eye Center
Professor Nagahisa Yoshimura Professor and Chairman Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine
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“The magnificent works at SNEC and SERI have led to profusely improved treatment and prevention for eye diseases, benefiting people in Singapore, Asia, and all regions beyond.” Professor C. P. Pang Chairman, Department of Ophthalmology and Visual Sciences Director, Shantou University / The Chinese University of Hong Kong Joint Shantou International Eye Centre
“During the course of 25 years, SNEC has made remarkable progress and achieved its goal of centre of excellence as set out by its founding Director, Professor Arthur Lim. Indeed, SNEC is now regarded as the top ophthalmic institution in the region in research, training and medical and surgical care.”
“You have been at the forefront of supporting your patients and developing high-quality eye care. Many patients can see again, thanks to the conscientious treatment provided by SNEC.” Prof Nguyen Trong Nhan President Vietnam Ophthalmological Society
Prof Ko Ko Thant President Myanmar Ophthalmological Society
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25 Years of Achievements “Our vision is for the Singapore National Eye Centre to attain international eminence within a decade.”
1991
1995
SNEC was officially opened by then Health Minister Mr Yeo Cheow Tong.
SNEC began providing a full range of subspecialty eye care services from cataract to glaucoma, neuro-ophthalmology and paediatric ophthalmology.
Dr Kwa Soon Bee Permanent Secretary (Health), Director of Medical Services and Chairman of HCS Pte Ltd appointed Professor Arthur Lim as the Medical Director-designate of the Singapore National Eye Centre.
“If you perform a good eye operation, you restore vision to one man. But if you spread the teachings of good quality eye surgery to your colleagues, they will ultimately restore vision to millions of blind victims in the world.” Professor Arthur Lim Founding SNEC Medical Director (1989–1999)
1990
1996
World-renowned eye surgeon Professor Arthur Lim was appointed SNEC’s fi rst Medical Director.
SNEC partnered key public hospitals such as Changi General Hospital and KK Women’s and Children’s Hospital to offer eye care services across Singapore.
SNEC saw its fi rst patient in October.
1997
SNEC hosted the 26th International Congress of Ophthalmology (ICO) for the fi rst time with 7,600 participants, the largest international conference in Singapore.
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The Singapore Eye Research Institute (SERI), the fi rst research institute dedicated to ophthalmic research in Asia, was officially opened.
“We want to be the first, the best, and the biggest.” Associate Professor Vivian Balakrishnan 2nd SNEC Medical Director (1999–2000)
1999 Associate Professor ofessor Vivian Balakrishnan was appointed ed as SNEC’s second ctor. Medical Director.
SNEC phase 2 extension began with a $50 million, eight-storey building comprising two floors of outpatient clinics, five operating theatres, and two floors of SERI’s research clinics and laboratories, among other facilities.
2000
“We must continue to uphold the values and the commitm commitment to the highest qual edical quality of medical ex e.” excellence.”
Professor Ang Chong Lye became SNEC’s third Medical Director.
SNEC held the fi rst annual ual National Eye Care Day with eye screening services for the elderly.
Professor Ang Chong Pro g Lye 3rd SNEC Medical Director 3 tor (2000–2008)
2003
2004
SNEC received the Excellence for Singapore Award for clinical and research breakthroughs such as conjunctival stem cell transplantation.
SNEC and the National Dental Centre performed the fi rst OsteoOdonto Keratoprosthesis (OOKP) surgery in Southeast Asia. Also known as ‘Tooth-in-Eye’ surgery, it is aimed at helping those blinded by end-stage corneal disease.
SERI released encouraging early fi ndings from the Atropine in the Treatment of Myopia (ATOM) clinical trial on children. A decade later, Atropine is now available as a treatment option for progressive myopia in children at SNEC.
The ASEAN Association of Eye Hospitals (AAEH) was inaugurated in Kuala Lumpur with SNEC being one of the five founding members comprising major eye hospitals in Indonesia, Malaysia, the Philippines, and Thailand.
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2012
“Our mission is to take care of anyone in Singapore who needs eye care. Every patient who walks through our door will receive good quality, evidence-based care.”
SNEC partners with Duke-NUS to launch the Ophthalmology & Visual Sciences Academic Clinical Programme, strengthening its academic medicine mission.
Professor Wong Tien Yin SNEC Medical Director (2014–present)
2014 SERI scientists discovered three genes linked to primary angle closure glaucoma (PACG), a leading cause of blindness in Chinese people, and published their fi ndings in the prestigious Nature Genetics journal.
SERI partners with Tan Tock Seng Hospital to introduce the Singapore Integrated Diabetic Retinopathy Programme (SiDRP), a national diabetic retinopathy screening programme at polyclinics.
SERI launched its inaugural fundraising gala dinner, The Eye Ball in October with President Tony Tan Keng Yam gracing the occasion.
Professor Wong Tien Yin was appointed as SNEC’s fi fth Medical Director.
The $5 million Arthur Lim Professorship in Ophthalmology was set up by SNEC and Duke-NUS. Professor Donald Tan was named the fi rst Arthur Lim Professor in Ophthalmology.
SNEC produced and made available Myopine™ eye drops (0.01% atropine) to reduce progression n of childhood myopia.
Two eye research teams were conferred the President’s Science and Technology Awards. The fi rst, led by Professor Wong Tien Yin and his team from NUS and A*STAR for the development of a suite of novel eye image analysis technologies and the other, led by Associate Professor Tina Wong and her team from NTU for the development of a sustained drug-delivery technology to apply anti-glaucoma medicine. Professor Donald Tan, Professor Aung Tin and Professor Saw Seang Mei from SNEC/SERI were named in the list of the world’s top 100 ophthalmologists in the UK-based journal, The Ophthalmologist. Professor Wong Tien Yin was named the world’s most prolific author on diabetic macular edema.
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2015 SNEC celebrates 25 years of service to the nation.
VISION TO REALITY
Numerous Firsts
The Straits Times 17 January 2013 The Business Times 30 May 2014
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The Straits Times, 4 September 2012
The Straits Times, 23 May 2006
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SNEC transmits ďŹ rst live surgery in 3-D HD at 21st APAO Congress
The Straits Times 16 June 2006
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Numbers at a glance Singapore National Eye Centre
300,000
65
30,000
patients visits annually
ophthalmologists in practice
people screened in our annual national eye care day since 2000
27,000
630
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surgeries performed annually
nurses, allied health, ancillary and administrative staff serving the eye care needs of Singapore
international meetings organised
8,000
130
30,000
laser procedures performed annually
local fellows trained in SNEC
students reached through eye care talks conducted in 30 schools since 2012
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100
subspecialties to provide a comprehensive range of specialised eye services
overseas fellows trained in SNEC
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Singapore Eye Research Institute
220
$198 million 105
researchers, doctors, clinicians, clinical scientists and administrators
in grant funding secured
patents ďŹ led
2,190
165
320
scientiďŹ c papers published
masters, PhD, post-doctoral students
national and international awards
1,098 studies on all aspects of eye research
Information correct as of December 2014
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Over the years, the Singapore National Eye Centre (SNEC) has evolved into a centre of excellence for ophthalmic service, research and education. SNEC 25 Highlights traces the key milestones and strategic initiatives in SNEC’s illustrious 25-year history that have made SNEC the institution it is today.
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Highlights 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.
Singapore comes of age in ophthalmology Mission impossible? Keeping an eye on quality Spectacular growth and Phase 2 expansion Punching above the pack Professor Arthur Lim — A giant ahead of his time Towards zero infection Restoring sight with tooth in the eye Nanomedicine: the new frontier Leading the fight against myopia Ushering the largest eye research meeting to Singapore The Eye Ball Eyes that tell stories SNEC wins multiple presidential honours Honouring Southeast Asia’s father of ophthalmology Standing tall among the best Striving for organisational excellence Nurturing human resource: SNEC fellowship programme Fostering a culture of academic medicine Going international: SNEC AHP training programme For your eyes only Enabling patient care, one app at a time Early detection is better than cure Age-friendly environment On the frontlines of ophthalmology
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Singapore comes of age in ophthalmology was showcased to the world ophthalmic fraternity. Organising the ICO was no mean feat. It required the organising committee to display the same mettle and precision that had served them well during surgical procedures. After all, the event had to host over 7,600 participants from 78 countries, including many key figures in ophthalmology at that time such as the legendary Professor A. Edward Maumenee, President of the International Council of Ophthalmology and dignitaries such as the late Singapore President Wee Kim Wee who officiated the meeting. With a stellar scientific programme comprising 16 simultaneous scientific sessions, hands-on teaching courses by world experts and over 1,000 scientific papers presented, the 26th ICO in Singapore was recognised as the most successful international congress in its heyday.
Even before the Singapore National Eye Centre (SNEC) was set up, the idea of a world-class ophthalmic centre in Singapore was already making its mark at the 26th International Congress of Ophthalmology (ICO) in March 1990. The prestigious event not only brought the global ophthalmology community to Singapore, many for the first time, but also exposed thousands of ophthalmologists around the world to the launch of what was potentially an international centre of excellence for clinical service, education and research for the whole of Asia. In many ways, the ICO was the coming of age for Singapore’s ophthalmology community, having made significant progress from the late 1970s to 1980s in microsurgery and numerous teaching and skills transfer courses organised locally and in the region. At the ICO meeting, the proposal on the formation of the SNEC was approved and a model of its building 26
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Mission impossible? While the need for setting up a national eye centre is apparent to many today, it took years of hard work and perseverance from the pioneering team to turn the vision into reality. The late Professor Arthur Lim, an eminent eye surgeon in private practice, first mooted the idea in the late eighties, but it would take many more years of discussions and negotiations with government officials to resolve key developmental issues. For instance, should the centre be developed within the National University Hospital, the private sector, or the Ministry of Health (MOH)? At that time, Dr Kwa Soon Bee, the Permanent Secretary and Director of Medical Services at the MOH felt that such an important development should be spearheaded by the government, and not by the private sector. Also, should the SNEC be a centre largely focused on service delivery or should it be a centre of excellence emphasising not only quality care but also top-notch teaching and research with the aim to become one of the best ophthalmic centres in the world? A decision was made to go with the latter, and the government eventually committed $17 million to build the SNEC in 1989. Dr Peter Tseng, Dr Heng Lee Kwang, Administrator Charity Wai, the late Matron Esther Lim among others were handpicked by Professor Arthur Lim and became the pioneering team responsible to transform the old surgical blocks A and B in the Singapore General Hospital into a modern ambulatory eye facility. The fact that the entire building was to be retrofitted and operational in just 10 months was thought to be mission impossible by many.
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Against all odds, the SNEC saw its first patient on 15 October 1990 and was officially opened in January 1991 by then Minister for Health Mr Yeo Cheow Tong. With state-of-the-art facilities ranging from modern ophthalmic theatres, fully equipped consultation rooms and laser centre to training rooms, patient education centre as well as a unique surgery observation and recording room that allows live surgery viewing and real time communication between surgeons and trainees, the stage is set for SNEC’s journey towards becoming a world-class institution.
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SNEC is one of the few eye centres in the world that records every single major eye operation. The reason: to use the recordings for teaching and monitoring of surgery to ensure high standards and outcomes. While this approach to evaluation of surgical skills is controversial at that time, SNEC believes it is the best way to ensure quality surgery for patients. The impact has been tremendous. At the SNEC, over 98 per cent of patients who undergo cataract implant surgery can expect a visual outcome of 6/12 or better, and a posterior capsule rapture rate of 1.2 per cent. Delivering quality services also means developing subspecialties to provide patients with specialised care and treatment. Over the years, the SNEC has nurtured a pool of talent in ten subspecialty services with capabilities to diagnose and treat all major eye conditions.
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Keeping an eye on quality
10 Subspecialties • General Cataract & Comprehensive Ophthalmology • Cataract • Corneal & External Eye Disease • Glaucoma • Neuro-Ophthalmology • Ocular Inflammation & Immunology • Oculoplastic • Paediatric Ophthalmology & Adult Strabismus • Refractive Surgery • Medical & Surgical Retina
The Straits Times 22 June 1991
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Professor Arthur Lim (centre), founding Medical Director; Associate Professor Vivian Balakrishnan (left), Medical Director of SNEC (1999-2000), being honoured by Professor Ang Chong Lye, incoming Medical Director of SNEC, who took office in September 2000.
Spectacular growth and Phase 2 expansion
The first 10 years saw SNEC enjoying spectacular growth. Patient load grew from 38,000 for the first year to 220,000 in the 10th year, a six-fold increase with education and research strengths growing in tandem. In his message for the SNEC’s 10th anniversary publication, Permanent Secretary for Health, Mr Moses Lee wrote: “In its first decade of development, the SNEC has made much progress… Ophthalmology as a discipline is advancing rapidly, with new technology, instrumentation and surgical procedures being introduced at an unprecedented pace…. with Singapore’s push to develop the life sciences sector, there are now exciting new research opportunities for SNEC and SERI in areas such as molecular genetics and functional genomics as applied to major eye conditions.” The Phase 2 development was greatly needed to see SNEC through its next phase of expansion, the idea of which was conceived as early as 1992 and went through numerous rounds of board deliberations and submissions to the Ministry of Health before it was finally approved in 1997. Constructed at a cost of $50 million, the extension wing added 15,000 sq m to the existing area of 6,500 sq m. The design of the new 8-storey purpose-built tower block clearly showed SNEC’s commitment to research and also marked the paradigm shift from developing high quality ophthalmic services to the need to push ophthalmic research and be at the cutting edge of medical innovation. Two floors were dedicated to house the Singapore Eye Research Institute (SERI) with its research clinics, basic science laboratories and comprehensive ancillary services. The cost of SERI
was funded under the first grant proposal for $19 million submitted to the National Medical Research Council by Professor Arthur Lim, Professor Chew Sek Jin, Professor Wallace Foulds and Administrator Charity Wai. In the SERI 2003/2004 annual report, major new initiatives were announced which saw the establishment of the SERI ophthalmic genetics laboratory and a proteomics facility in response to the national initiative towards life sciences. Education as another important pillar of SNEC’s activities also received a boost with the inclusion of a 110-seat auditorium capable of transmission of live surgery demonstration, a library/resource centre and dedicated training rooms. This period also saw the passing of the baton and smooth transition of leadership from founder Professor Arthur Lim to Associate Professor Vivian Balakrishnan (1999 to 2000) and Professor Ang Chong Lye who became Medical Director from 2000 to 2008.
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Punching above the pack FRIDAY, JUNE 27, 2014
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Singapore can learn much from the US experience when it comes to integrating academic research with improved health care.
Let research loop back to patient care Engage the public as a stakeholder
By WONG TIEN YIN FOR THE STRAITS TIMES
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N 1987, Mr Philip Yeo, then chairman of the Economic Development Board, went to the United States as an Eisenhower Fellow. His observations of the R&D scene there shaped his vision for the establishment of the Agency for Science, Technology and Research, or A*Star, and the foundation of Singapore’s biomedical sciences initiative. Established in 1991, A*Star is a statutory board that fosters scientific research and talent to promote a knowledge-based Singapore. Last year, I was privileged to be selected as one of Singapore’s Eisenhower Fellows to spend seven weeks in the US. As a physician and scientist, my aim was to look out for lessons to shape the future of Singapore’s health-care ecosystem. Singapore already has a strong reputation for high-quality, cost-effective health care. Yet the country is faced with significant challenges, including ageing, chronic diseases and increasing health-care costs. How can Singapore use the biomedical research innovation that it has built to provide better care to patients and thereby create Singapore Medicine 2.0? During my fellowship, I visited 10 cities and 30 hospitals, universities, and research institutes. I met doctors, academics, scientists and CEOs. This is what I learnt:
Academic centres shape innovation and care AN ACADEMIC medical centre (AMC) is a university-hospital partnership that has a triple mission: patient care, research and teaching. In Singapore, we currently have two health-care clusters that function as AMCs. They are the SingHealth/Duke-NUS partnership in Outram, and the National University Health System at Kent Ridge. Among the major AMCs that I visited in the US are the Harvard-Massachusetts General Hospital system, the Mount Sinai University Health System in New York, the Stanford University Medical Centre, and the Duke University Health System. For decades, these AMCs have provided new understanding of how diseases develop. They have also discovered new treatments and methods of prevention that are now widely practised globally. However, the most useful lessons for Singapore come from an unexpected place: the University of Pittsburgh Medical Centre (UPMC), Pennsylvania. This AMC was developed in the 1970s, and has done very well in a short span of time. Prior to 1970, the economy of the Pittsburgh region was dominated by coal and steel mining. Today, thanks to a strong university-hospital partnership, it is a hub for health care, education and innovation. How did they do it? It started
with a vision and commitment from the two partners – the hospital and university – to help each other succeed in a single mission of “research-based patient care�. By providing access to patients, the hospital helped the university do better at clinically relevant research. This research in turn helped improve patient care within the hospital, thereby strengthening the reputations of both institutions. The hospital-university partnership became attractive employers for top-notch doctors and researchers from around the country. It also started winning large research grants. Young clinician-scientist stars, the hybrid talents that help translate biomedical research into clinical care, started flocking to Pittsburgh. This sustained the system and attracted even better physicians. And all the while, patients and the community benefited from getting better care. An example is the work of UPMC’s transplant pioneer, Professor Thomas Starzl. He was a surgeon who first used antirejection drugs to make liver and other human organ transplanta-
To bring innovation into our health-care system we need a diversity of talent. We risk losing talented people and invaluable contributions when holding too rigidly to a “one size fits all� approach. tion possible. UPMC’s Starzl Institute has since saved thousands of lives, and attracted many aspiring young surgeons to train and join UPMC as faculty members. Pittsburgh is now known as the “transplant capital of the world�. This virtuous circle revolves around the commitment to treat success in research and success in clinical outcomes as inter-dependent outcomes. This is actually easier said than done. Initial commitments might waver under the pressure of short-term returns, the tendency to protect one’s own turf, or the (mistaken) belief that research in health care is “optional�, and only when economic times are good. In Singapore, our emerging AMCs need to be similarly nur-
tured and supported as the focal point of Singapore Medicine 2.0. It is difficult to create a fully functioning virtuous loop when there are more immediate strains in our health-care system. But doing so needs to be our priority if Singapore Medicine 2.0 can ultimately create better long-term outcomes for patients and the community.
Develop a diversity of talent in system WHEN I met Professor Cherry Murray, dean of engineering at Harvard, I was surprised at the unconventional route through which she had landed the job. With only 80 academic papers, she is less well-published than most of her faculty. However, her curriculum vitae
is different. Prof Murray started out in academia but spent many years successfully leading R&D teams at Bell Labs before coming back to her position as dean. By appointing her, Harvard showed a healthy disregard for academic excellence, narrowly defined. Singapore’s health-care institutions typically follow conventional understanding in hiring and promotion. This excludes people who have had less conventional careers but who could contribute greatly to the success of innovation. Prof Murray’s case prompts reflection on how good we are in Singapore at rewarding and cultivating a diversity of talent, and how this has an impact on making Singapore Medicine 2.0 a reality. To bring innovation into our health-care system we need a diversity of talent. We risk losing talented people and invaluable contributions when holding too rigidly to a “one size fits all� approach. Can we be bolder in supporting diverse and talented people who can bring innovation into our health-care system?
THE calibre of Singapore’s health-care system and our biomedical research is already high. However, compared to the US, we have a long way to go in building a legacy and tradition. Take for example the famous Ether Dome at Massachusetts General Hospital (MGH), where general anaesthesia was first administered in 1846. Imagine its significance for health-care workers at MGH, and those who enter the hospital as patients, or even those who visit the Ether Dome as tourists: they feel part of a lasting legacy. I am not suggesting that Singapore can create a similar history immediately. But Singapore can learn from how American AMCs work to create, treasure and sustain a legacy in the present day. They do this through a culture of gratitude, and of sharing this with the public as a stakeholder in their health-care, research and teaching journey. In the Boston subway, I saw an advertisement that Harvard offers free science seminars to the public: “No prior knowledge necessary.� Imagine such a poster on our Singapore MRT! In other poster ads, hospitals and universities advertise themselves as change-makers in science and medicine, informing the public about new treatments and approaches they are working on. The broad dissemination of the goals and achievements of biomedical research helps maintain public engagement in these institutions and what they stand for. In building Singapore Medicine 2.0, we should take seriously the role of public engagement and the need to instill a sense of ownership among not just those working in the sector, but also the general community. We need to create that gravitational pull that makes young aspiring Singaporean doctors, researchers, patients – and indeed any curious individual – want to inherit and further the legacy. As a physician and scientist whose career unfolded against the backdrop of the biomedical sciences initiative, I believe that developing three effective strategies is the way towards Singapore Medicine 2.0. Singapore should build AMCs that bridge hospitals and universities which are sustained by a virtuous loop between better patient care and research outcomes. The country should develop a diversity of talent and, finally, engage the public as a key stakeholder in the health-care innovation journey. Dr Catelijne Coopmans, fellow and director of studies at Tembusu College, NUS, contributed to this article. Wong Tien Yin is professor and vice-dean, Duke-NUS Graduate Medical School, National University of Singapore (NUS), and deputy medical director of the Singapore National Eye Centre. stopinion@sph.com.sg
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Since its inception in 1997, the Singapore Eye Research Institute (SERI), the research arm of SNEC, has achieved international recognition for the quality of its research. It punches above its weight with Singapore generating the highest number of eye publications per capita in the world amidst global heavyweights such as the United States, United Kingdom and Japan, as reported in The International Ophthalmology journal. About 95 per cent of ophthalmic research done in Singapore is carried out by SERI. More importantly, SERI’s research has translated into more effective clinical care for patients suffering from conditions such as corneal diseases, myopia, age-related macular degeneration and glaucoma. The institute is also at the forefront of developing natural anti-microbial drugs that will see potential beneďŹ t going beyond treating eye conditions. As of December 2014, SERI’s researchers have 320 national and international prizes plus 105 patents under their belt, including winning the President’s Science and Technology Award three times. With a multinational faculty comprising 220 researchers, doctors, clinicians, clinical scientists and administrators, SERI is one of the largest research institutes in the Asia-PaciďŹ c region. Separately, an independent panel also found that from 2002 to 2006, SERI had 64 research papers published in top science and medical journals, Johns Hopkins University had 54 and the University of Melbourne’s Centre for Eye Research Australia had 33.
Professor Arthur Lim
A giant ahead of his time
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Much of SNEC’s success is credited to Professor Arthur Lim, a true visionary who had laid the groundwork that would put SNEC on the world map. In a special ceremony on 20 January 2014, SNEC and Duke-NUS Graduate Medical School Singapore launched the $5 million prestigious Arthur Lim Professorship in Ophthalmology to recognise Professor Lim for his lifelong dedication and commitment to developing quality eye care, education
and research in Singapore and in the region. Guest-ofHonour, Minister Vivian Balakrishnan gave a personal tribute to his mentor. The first Arthur Lim Professorship in Ophthalmology has been conferred on Professor Donald Tan, Senior Consultant Ophthalmologist, Corneal and External Eye Disease Department, SNEC, and Senior Principal Clinician Scientist at SERI in October 2014.
Excerpts from Dr Vivian Balakrishnan’s speech highlighted Professor Lim’s seven outstanding attributes:
that by the time you reached a patient, you were sharp, and able and could honestly say you’re doing the best for the patient. 5. His investment in research He was a man ahead of his time and persuaded the Ministry of Health and the National University of Singapore, probably against their own conventional thinking at that point in time, “take a bet, invest more money into research”. 6. His devotion in nurturing his juniors He was a tough boss to work under. He would never suppress or keep down a junior because he was worried that you would compete or surpass him. He had this generosity of spirit, born out of confidence in his own ability and the keenness to make sure that his subordinates could go beyond him. 7. Professor Lim – An exemplary life to emulate The most important measure of a man’s lifetime achievements is actually not just the sum of all the work that he himself has done – of the thousands of cataracts that he has removed, or the hundreds of thousands of patients that he has seen. The real test of man’s legacy is who are the people and the institutions, and the systems that will persist, after that giant is no longer in the scene. That he has given us so much and it is our duty to emulate him by paying it forward and to make sure that this legacy grows.
1. His ability to dream big For him, life isn’t about counting a few pennies, timid plans, or lowering your ambition in order to improve your chances of success. It’s always been about the big really difficult and massive challenges out there. 2. He translated dreams into reality He was able to translate dreams into reality by his sheer force of personality, his great persuasiveness, and his ability to make things happen. 3. He asserts moral authority It is not just about legislation or policy or grants, but that all of us feel the need to follow someone because he appeals to this innate desire in all of us to do something worthwhile, something bigger and larger than ourselves. 4. His steadfast belief that patients deserve the best Because he believed that patients deserve the best, he insisted on structured, rigorous training for ophthalmologists and for surgeons. You had to train properly, you had to learn to stitch in the lab, learn how to use a microscope, work on animal eyes, slowly move your way up so
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Towards zero infection
As eye care providers around the world grapple with infection rates, SNEC has proven that it is possible to achieve a zero infection rate by adopting an ‘obsessivecompulsive’ approach to delivering clinical services. Every major operation is recorded for the monitoring of results and an independent Clinical Audit Department has been set up to evaluate surgical outcome data of all the various subspecialties and to benchmark to the ‘best-in-class’ internationally. A comprehensive infection prevention programme is also in place with an annual seminar which requires compulsory staff attendance. In 2007, the press highlighted SNEC’s record of zero infection rate for 17,000 operations, which included cataract and refractive procedures. A zero infection rate is considered rare, as one out of a thousand cataract patients may develop post-operative infection, according to the American Academy of Ophthalmology.
The Straits Times 23 May 2009
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The Straits Times 25 May 2005
Restoring sight with tooth in the eye
8 Highlight
Since then, 51 more OOKP surgeries have been successfully performed for patients from Australia, Indonesia, Malaysia, Sri Lanka, Thailand, Vietnam and Singapore. The SNEC’s leadership in OOKP surgeries was recognised at the American Society of Cataract and Refractive Surgery Annual Meeting in 2005, when the SNEC’s OOKP surgical team won the First Place Film Award under the new techniques category – the first for Singapore surgeons. Several countries in the region have also initiated their own OOKP programmes, and have approached SNEC to assist with training.
Luck Pewnual, a 19-year-old boy from Thailand, completely lost his sight in both eyes from a rare allergic reaction. But thanks to a team of SNEC eye surgeons and a dental team from the National Dental Centre that successfully performed a ‘tooth-in-eye’ surgery in 2004, Pewnual is able to see again. The surgery was the first successful case of Osteoodonto-keratoprosthesis (OOKP) surgery in Singapore, and the first of its kind in the region. The procedure involves removing a canine tooth from the patient, shaping and drilling it to allow implantation of an artificial plastic corneal device (optical cylinder), and ultimately implanting it back into one eye a few months later. 33
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Nanomedicine: the new frontier
The Straits Times 31 January 2013
In Singapore, about three per cent of people over the age of 50 years have glaucoma, an eye condition caused by high intraocular pressure in the eye that could damage the optic nerve. This percentage increases with age — from two to three per cent among those 50-60 years of age to 10 to 12 per cent for those over the age of 70 years. The SNEC receives up to 40,000 glaucoma patients each year. With advancements in nanomedicine, administering eye drops to lower the high pressure in the eyes will become easier. In 2014, Associate Professor Tina Wong, Senior Consultant, Glaucoma Department, SNEC, who is also Head of Ocular Therapeutics and Drug Delivery Research Group and Principal Clinician Scientist at SERI, worked together with Nanyang Technological University to successfully develop a new nanomedicine that is delivered to the front of the eye via a painless injection. The nanomedicine will stay and release antiglaucoma drugs slowly over the next six months, helping patients, especially the elderly, do away with daily eye drops which will greatly improve compliance and preservation of vision. At least 10 per cent of blindness from glaucoma is directly caused by poor patient adherence to their prescribed medications, due to reasons such as forgetfulness, ďŹ nding it too troublesome, or a lack of understanding of the disease. 34
Fighting myopia, 1 eye drop a night Global leader in eye research
B4
WEDNESDAY, DECEMBER 18, 2013 ST PHOTO: ALPHONSUS CHERN
Several eye operations are carried out simultaneously in different theatres at the Singapore National Eye Centre, whose doctors see about 275,000 patients a year.
Eye-drops for kids with severe myopia Drug which slows down condition available only at SNEC for now By SALMA KHALIK SENIOR HEALTH CORRESPONDENT
CHILDREN who suffer from rapidly deteriorating myopia can now turn to a new treatment offered by the Singapore National Eye Centre (SNEC). Its low-dose atropine eye-drops, which cost less than $20 for a month’s supply, can slow down short-sightedness by as much as 60 per cent, said Professor Donald Tan, the SNEC’s
medical director. “It would be fantastic if a child who would normally end up with myopia of 800 degrees is able to keep it to 400 degrees or less,” he added. The SNEC will provide the drops to as many children here as possible. But if its paediatric clinics cannot cope with the expected high demand, Prof Tan said the centre will open more clinics. About one in six children here suffer from severe myopia of 600 degrees of more by the time they
are in their late teens. This puts them at risk of getting cataract at an early age as well as other eye problems like macular degeneration and retinal detachment. SNEC’s five-year trial of 400 children, which began in 2006, found that the daily use of low-dose atropine showed no noticeable side effects. Instead the drops, which retard the elongation of the eyeballs which leads to myopia, proved a success in slowing down the condition. For some children, it even arrested the short-sightedness from getting any worse. Prof Tan’s wish is to see the drug became widely accessible,
but there are regulatory hurdles to overcome. The SNEC tried to interest pharmaceutical companies to produce the eye-drop, but with no success. Prof Tan said this is because the company would need to carry out expensive trials to get regulatory approval. But because it is an old drug that is no longer under patent, once a company has obtained approval, others could simply produce and sell similar eye-drops. SNEC finally decided to pay a company to make the eye-drops. But until large-scale trials are conducted to meet regulatory demands, these drops can be dis-
pensed only by SNEC’s pharmacy, and all patients have to be logged. Prof Tan hopes to be able to conduct trials that will satisfy health regulators within a few years – together with eye centres in other Asian countries facing a high incidence of myopia, such as China. When that happens, the eyedrops can then be dispensed by any doctor. Until then, SNEC will be the only place supplying these eye-drops to patients in general to prevent worsening of myopia. About 85 per cent of teens here are myopic, with the condition generally starting when a child is five or six years old.
Usually, the fastest deterioration occurs between the ages of seven and nine years. Prof Tan stressed that while the drops can slow the progression of myopia, they cannot cure it. Parents can call 6227-7266 for an appointment, or e-mail appointments@snec.com.sg Those who want subsidised treatments need a referral from a polyclinic. Parents should bring along proof of their child’s deteriorating myopia, such as the need for a new pair of spectacles every few months. salma@sph.com.sg www.facebook.com/ST.Salma
Solution with tweaked dosage of atropine causes myopia in kids to slow and improve
OTHER BREAKTHROUGHS
Alphonsus Chern Singapore researchers have found a way to put the brakes on myopia in children, and even improve the eyesight of a lucky few. Doctors say a simple eye drop could be the best solution to fighting short-sightedness, which afflicts eight in 10 people here by the time they are adults. “We think we have found the answer to reducing the progression of myopia in children,” said Professor Donald Tan, chairman of the Singapore Eye Research Institute (Seri), who led the latest study. “There is reasonable evidence that reducing near-work activities such as reading and playing computer games may slow it down, but not by such a huge margin as the eye drops.” Seri has tried battling myopia on several fronts – using computer software to exercise the brain and an eye gel, for example – but nothing has proven as successful as the latest eye drops. They contain a very dilute solution of the chemical atropine, which has been proven to slow myopia, but can cause problems such as glare and the loss of near vision in higher concentrations. “We were extremely pleased to find that the children had almost no side effects and the drug was absolutely safe,” said Prof Tan of the latest study.
ST PHOTO: ALPHONSUS CHERN
Staff involved in some of Seri’s new projects include researchers (from left) Eranga Vithana, senior principal scientist and associate director of basic and experimental sciences; Jodhbir Mehta, head of the tissue engineering and stem cells research group; and Tina Wong, head of the ocular therapeutics and drug delivery research group.
Singapore is the myopia capital of the world, where 7 per cent of five-year-olds are short-sighted and more than 60 per cent are myopic by the time they are in Primary 6. High myopia rates mean more individuals have severe myopia, said Dr Audrey Chia, an adjunct clinician investigator at Seri, adding that they are also at risk of developing potentially blinding eye conditions such as retinal holes, retinal detachment and even glaucoma. With the new eye drops, myopia in an average child increased at only half the usual rate, so a child who might have had a short-sight-
edness level of 1,000 degrees in one eye might have a level of just 500, she added. Such eye drops generally do not work on adults as their myopia, if any, would be fully developed. Myopia occurs when the eyeball grows longer than normal, making it unable to focus on distant objects, and atropine works by slowing this growth. Seri’s study was the first in the world to fine-tune the dosage. At a 0.01 per cent concentration – 100 times lower than previously used – the solution worked well with no side effects.
Ocular drug delivery system Researchers at the Singapore Eye Research Institute (Seri) have found a way to inject slow-releasing drugs into the eyeball. This could free people with glaucoma from having to use eye drops daily or risk a worsening of their condition, which could lead to blindness. Designed to mimic cell membranes in the human body, the special particles developed at Seri can stay in the eye for up to four months, slowly releasing the medication. If trials show the injection treatment works, it could benefit the 10,000 people who go to the eye centre for glaucoma treatment every year.
“We feel we have finally arrived at an ideal therapy in 0.01 per cent atropine eye drops,” said Prof Tan. “No other approach seems to be as effective and safe.” The five-year trial that ended last year involved 400 children, aged six to 12, who applied a single drop every night. Anglo-Chinese School (Independent) student Nikhil Daniel Angappan was 10 when he joined the study. At the time, he was moderately short-sighted, with 225 degrees in the left eye and 250 degrees in the right. Now 16, his short-sightedness has stopped at 150 degrees in his
Corneal surgery A new laser treatment to correct short-sightedness may be able to reverse it later in life, when patients develop presbyopia, or long-sightedness, instead. Unlike conventional Lasik surgery that vaporises corneal tissue, the new surgery removes a lens-shaped piece of the cornea without destroying it. The piece of corneal tissue, called a lenticule, can be stored and later retrieved to treat the same patient’s presbyopia. It can even be donated to corneal transplant patients. This procedure is not unlike cord blood banking, where an infant’s cord blood, stored at birth, may be used years later to treat immune system and blood-related disorders.
left eye and 175 degrees in his right. “This really was a fantastic programme,” said Nikhil, who likes to play rugby. “There was a reduction in myopia and I was still able to have an active lifestyle.” The eye drops are expected to be available to all children here by the middle of next year. At the same time, a further study involving up to 600 children will begin, said Prof Tan. This will fulfil drug registration requirements and test the new eye drop’s performance in a real world setting.
Founded in 1997 with just 11 employees, the Singapore Eye Research Institute (Seri) now has 192 staff, and plans to double its strength over the next decade. It does more than 90 per cent of eye research here, and its prolific output has catapulted Singapore into the global top spot in the field, ahead of heavyweight eye research centres in the United States and Britain. According to Web of Science, an online academic citation index, Seri is among the top four publishers of ophthalmology-related publications worldwide, alongside the University of London’s Moorfields eye hospital, and the Johns Hopkins and Harvard universities in the US. The journal International Ophthalmology has also highlighted Singapore as the leading contributor of publications per population worldwide. By December last year, Seri conducted more than 850 eye-related studies, received over $120 million in competitive grants, published more than 1,400 scientific papers, received 200 awards for its work and registered 37 patents for its inventions. It is also punching above its weight in other areas of research. For instance, it has found a way to reliably predict diseases such as stroke, diabetes, hypertension, dementia and kidney disease by looking at retinal blood vessel damage. A research study that analysed the retinal images of 15,000 patients, combined with the person’s age and blood pressure, was able to predict a stroke with 80 per cent accuracy. This method is now being tested in some clinics, but the project is still several years away from completion. With just $3 million in annual core funding from the Ministry of Health, Seri competes with other groups here and overseas for additional funding, and is hoping to raise more money through endowment grants for research. It has also run out of space, and there are plans to house the institute together with the Singapore National Eye Centre in a new building, so that researchers can remain in close contact with the doctors who see about 275,000 patients every year. Alphonsus Chern
achern@sph.com.sg
The Straits Times 13 November 2012
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Leading the fight against myopia
Myopia has plagued Singapore for years, with eight in 10 people afflicted with the condition by the time they reach adulthood. While reducing near-work activities might slow down its progression, more effective measures were needed to nip the problem in the bud. After more than 15 years of clinical trials, researchers and clinicians at SERI and SNEC have
discovered that eye drops with lowdose atropine of 0.01% could slow down the progression of myopia in children by up to 60 per cent with minimal side effects. Their findings have evolved into an eye drop, which can be administered for children in a dedicated myopia clinic. Produced and made available in SNEC, the atropine eye drop, called Myopine™, is suitable for children 35
between the ages of six and 12 years with progressive myopia. Meanwhile, community-based clinical trials are underway to address the lack of physical and outdoor activities which are also thought to be a major cause of myopia. Together with low-dosage atropine, this major national problem may be addressed in the near future.
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11 Ushering the largest eye research meeting to Singapore
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For the first time, Singapore played host to one of the largest gatherings of top ophthalmic minds, through the inaugural SERI-ARVO (The Association for Research on Vision and Ophthalmology) Meeting on Vision and Ophthalmology in February 2003. This is the first time an ARVO meeting, which is the largest research meeting with annual attendance of over 10,000 participants, is held outside the United States. More than 600 speakers and delegates from 37 countries attended the outstanding programme, packed with keynote lectures and symposia covering myopia and physiological optics, glaucoma, stem cell biology, genetics and ocular inflammation, among other subspecialties. Singapore researchers also presented the results of eye stem cell culture and transplants, as well as clinical trials of low-dose atropine to slow down myopia progression. The participants also took part in workshops covering areas such as designing and conducting clinical research, as well as writing successful grant and scientific papers.
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The Eye Ball
To meet the increasing competitive landscape for government grants and funding, SERI had to develop innovative ways to raise funds to support its research efforts and hence The Eye Ball was conceptualised. For the past three years, SERI has been organising The Eye Ball, a gala fundraising dinner to raise awareness of eye research, and to support SERI in its effort to perform impactful research that directly beneďŹ ts the community. It has raised $1.3 million so far.
The most recent Eye Ball was held at the Fullerton Hotel on 24 October 2014 where an auction of previous jewellery and art pieces was conducted. Supported by Singapore Tatler magazine, the event made it possible for SERI to grow its proďŹ le. Other initiatives are being planned to build up its fundraising capability in a sustained manner.
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Eyes that tell stories
The public had a chance to peer into the eyes of 14 of Singapore’s iconic personalities in the Eyes that Tell Stories exhibition held at the Red Dot Museum in June 2011, as part of SERI’s efforts to create awareness of eye diseases and vision loss, and the importance of eye research. The exhibition featured eye images taken using cutting-edge ophthalmic equipment. The personalities’ images — including Singapore’s founding Prime Minister, the late Mr Lee Kuan Yew and film director Royston Tan — reflected how their eyes have played an integral role in the pursuit of their respective passions. Also showcased at the exhibition were poignantly ‘beautiful’ images of damaged or diseased eyes from patients that reveal the fragility of eyesight and vision, which is often taken for granted. Through the 10-day exhibition, the public also got a chance to learn more about how photographic images of the eye can be used in the diagnosis and management of eye disease. 38
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SNEC wins multiple presidential honours
SNEC has the distinctive honour of winning the highest presidential honours in science and technology four times over the years. This sterling achievement is unmatched by any other healthcare institutions in Singapore.
The first PTA was presented to a team comprising Professor Wong Tien Yin, Medical Director of SNEC and Professor Wynne Hsu and Professor Lee Mong Li from the National University of Singapore, in collaboration with SERI and A*STAR’s Institute for Infocomm Research (I2R). The team had developed an eye image analysis platform to help doctors detect and track the progression of three major eye diseases such as glaucoma, diabetic retinopathy and agerelated macular degeneration, as well as to study the onset of systemic vascular diseases such as stroke, heart disease and diabetes. Another PTA was conferred on a team comprising SNEC’s Associate Professor Tina Wong, Senior Consultant, Glaucoma Department, Head of Ocular Therapeutics and Drug Delivery Research Group and Principal Clinician Scientist, SERI, as well as Professor Subbu Venkatraman and Professor Freddy Boey of Nanyang Technological University. They found a way to enable sustained release of glaucoma medication, by using a single injection of nanomedicine for the delivery of medication for up to six months. Their work will go a long way to prevent blindness caused by patients’ non-compliance with daily eye drop treatment.
2009 Professors Donald Tan, Roger Beuerman and Aung Tin were the pioneer recipients of the prestigious President’s Science Award for their innovative breakthroughs in ‘bench-to-bedside’ medical research in blinding corneal diseases and glaucoma, leading to major advancements in scientific knowledge and the treatment of these diseases. 2010 Professor Wong Tien Yin, then SERI Director, was awarded the President’s Science Award 2010 for the development and use of novel retinal imaging to understand pathways in cardiovascular and metabolic diseases. 2014 SNEC received double honours winning the highest national research awards – the President’s Technology Award (PTA) – for two cutting-edge research projects that underscored the centre’s commitment to clinical innovation.
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15 Honouring Southeast Asia’s father of ophthalmology Without the leadership and vision of the late Professor Arthur Lim, Singapore would not have achieved its world-class status in ophthalmology, which roots could be traced back to Professor Lim’s inauguration of the Singapore Eye Foundation in the 1980s. In August 2014, we mourned the passing of Professor Arthur Lim, Southeast Asia’s father of ophthalmology. Numerous tributes came from all corners of the world reflecting the indelible mark Professor Lim has made in ophthalmology influencing not only Asia but the world.
“Arthur was a visionary and a giant in Singapore medicine. He was a world leader in clinical and academic ophthalmology and made substantial contributions to the field. He founded the Singapore National Eye Centre, which is now one of the world’s leading eye hospitals. He also conceptualised the Singapore Eye Research Institute, which has over the last two decades made discoveries that advanced the diagnosis and treatment of major eye diseases, such as myopia, glaucoma, and diabetic retinopathy. He put Singapore medicine on the world map, serving as President of the World Ophthalmology Congress and Secretary General of the Asia Pacific Academy of Ophthalmology, which he helped set up.” Lee Hsien Loong Prime Minister of Singapore
“He will be remembered for setting up the Singapore National Eye Centre, and serving as its founding Medical Director. It was also through his vision that the Singapore Eye Research Institute was set up, at a time when there was hardly any research on ophthalmic vision in Singapore. He was also instrumental in setting up the Department of Ophthalmology at the National University Hospital and National University of Singapore. Over the years, he mentored several generations of eye surgeons in Singapore, due to his generosity to teach and impart knowledge to others.” Gan Kim Yong Minister for Health
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Tributes from around the world “Arthur was my friend, mentor, colleague, and inspiration for 40 years. He was a rare visionary who never wavered in his dream to make Singapore a global leader in ophthalmic care, education, and later, research. This he extended to the whole Asia-Pacific region and especially China.”
“Very few of us can be said to have had a transformative impact. Prof Lim had that kind of impact on global ophthalmology. He will be sorely missed.” Dr David W. Parke II Executive Vice President & CEO American Academy of Ophthalmology
“He was a giant in ophthalmology and a world leader with a profound and worldwide influence.”
Ian Constable Professor of Ophthalmology University of Western Australia, Australia
Professor Hugh R Taylor President, International Council of Ophthalmology
“I was greatly saddened when I received your e-mail informing me of Arthur’s death. I knew Arthur for so many years and was well aware of the great debt owed to him by so many people. As you know neither the SNEC nor SERI would have been in existence without his foresight and his energy in promoting world class ophthalmology in Singapore. He will be missed by many.”
“The passing away of Prof Arthur Lim marks the end of an era for Ophthalmology in the region. His dynamism and ability fuelled the growth of the specialty in the region and brought the Ophthalmologists in the region together.” Dr Ashok K Grover Past President All India Ophthalmological Society
Professor Wallace Foulds Senior Consultant Advisor Singapore Eye Research Institute
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“Prof Lim made significant contributions to the development of ophthalmology in China and Asia. We have lost a giant in ophthalmology, a great teacher and mentor of thousands of ophthalmologists in Asia and beyond.”
“I vividly recall the first time I met Arthur when he first established the Asia Pacific Intraocular Implant Society in the 1980s. His vision of the importance of a regional group focused on cataract surgery and intraocular implants like so many of his insights proved to be correct and that small group has grown into APACRS and all its associated activities. Similarly, he planted the seed for many other societies, which now contribute to education and training in the Asia-Pacific region.
Li Xiaorong Director, Tianjin Medical University Eye Hospital, China
“He was tireless in his efforts to teach younger ophthalmologists, creating a unique community of experts in the region, and a great friend to many of us.”
“He entrusted me with the future of the Asia Pacific Intraocular Implant Association and therefore changed my life as he did for so many others whom he met, guided, and invested time in their future and careers. He achieved all this with an enthusiasm and engagement with life that was truly inspirational.
Fang Seng Kheong President, Malaysia Society of Ophthalmology (MSO), Malaysia
“I was profoundly saddened to hear the sad news of the passing of Prof Arthur Lim. We have lost a great ophthalmologist, a great man, and I have lost a great friend.”
Graham Barrett President, Asia-Pacific Association of Cataract & Refractive Surgeons President, Australasian Society of Cataract & Refractive Surgeons Consultant Ophthalmic Surgeon, Sir Charles Gairdner Hospital, Western Australia
Ningli Wang President, Chinese Ophthalmological Society Vice President, Beijing Tongren Hospital Chief Ophthalmologist and Director, Department of Ophthalmology, Beijing Tongren Eye Center, China
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(Left to right): SNEC Chief Operating Officer, Ms Charity Wai; Professor Donald Tan, then Medical Director of SNEC; Professor Arthur Lim; Mrs Lim and Professor Wong Tien Yin, present Medical Director of SNEC.
Attracting the best talent to the centre was a priority that Professor Arthur Lim had advocated. In honour of his visionary contributions to ophthalmology, the $5 million Arthur Lim Professorship in Ophthalmology was launched in January 2014. “This Professorship will focus on attracting top talent locally and around the world to help us advance the frontiers of ophthalmology,” said Professor Donald Tan, then Medical Director of SNEC. “Enshrining this professorship is also a lasting tribute from all of us in SNEC and SERI to thank Professor Lim for his significant legacy he has left us as our Founding Father, Leader, Advocate, Teacher and Mentor.”
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16 Standing tall among the best
Three ‘visionary’ doctors from SNEC and SERI made the headlines in 2014 for making it into a list of the world’s most influential people in ophthalmology compiled by the British journal, The Ophthalmologist. Professor Donald Tan is third among the Who’s Who list and only the top 20 ophthalmologists are ranked. Professor Tan was recognised for his roles in myopia trials, and cornea surgery and transplant, while Professor Aung Tin, Executive Director of SERI, was lauded for his insights into angle closure glaucoma. Professor Saw Seang Mei, who is an epidemiologist with Saw Swee Hock School of Public
Health and also the Co-head, Myopia Research Group at SERI, has worked extensively in the area of myopia, including environmental factors that affect shortsightedness. She is one of only 13 women to make the list. The ranking was compiled from nominations from the journal’s readers, who mostly hail from Germany, Australia and the United States. The journal also highlighted Professor Wong Tien Yin, Medical Director of SNEC as the most prolific author in the area of diabetic macular edema, a major cause of vision loss in diabetics.
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Striving for organisational excellence Over the years, in tandem with outstanding clinical accomplishments, SNEC has also attained various accolades for achieving organisational excellence. In 2005, SNEC achieved accreditation for ISO 9001:2000 which affirmed that the organisation has maintained high standards in quality management system and all areas of the business, including: facilities, people, training, services and equipment. It also calls for continual improvement in work practices throughout the entire organisation. In the same year, SNEC was also accorded the Singapore Quality Class award which is a national recognition for organisations with management systems and processes in place to achieve all-round business excellence. SNEC went on to achieve the Servicert™ accreditation in 2007 and further the ISO UKAS (United Kingdom Accreditation Service) 9001:2000
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certification in 2008. Additionally, the centre has also accomplished the People Developer Standard which recognised SNEC for its high standard of practice in human resource management and the Business Continuity Management award certifying SNEC’s attainment in risk management system and processes. SNEC also became the first ambulatory eye institution in Singapore to achieve the Joint Commission International (JCI) accreditation in 2009, and subsequently, a re-accreditation in 2012. This international endorsement for quality patient care and safety as well as organisational management excellence has helped SNEC to be continually focused on delivering high quality patient-centric care without compromise. The process encompasses the entire organisation and requires senior management involvement and not just a function of the Quality Service Department. 45
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18 Nurturing human resource: SNEC fellowship programme
With education as one of the key pillars of SNEC’s development, it is no surprise that much emphasis has been placed throughout its history to teach and nurture a new generation of ophthalmologists in various subspecialties. Since 1990, over 100 international fellows from all over the world and another 130 local fellows have been trained through SNEC’s highly sought after fellowship programmes. One in two ophthalmologists in Singapore has received training in SNEC. During a typical one-year fellowship, fellows would see patients with the full-time faculty and conduct surgical procedures. They would also participate in continuing medical education programmes and teaching rounds within the clinical departments. Many senior consultants who completed their fellowships in SNEC have become experts, heads and mentors to fellows in their respective subspecialties. Some have even gone on to become leaders in ophthalmology in their own countries and have set up their own eye centres. The SNEC also works with the Asia Pacific Academy of Ophthalmologists, Fred Hollows Foundation and Commonwealth Eye Consortium under the Queen Elizabeth Diamond Jubilee Fund to offer SNEC fellowships in selected specialties.
Dr Marc Lawrence Weitzman First fellow (1992)
Dr Grace Gray Mugume Second fellow (1993)
Dr Zhao Shao-Zhen Third fellow (1994)
Dr Paul Foster Fourth fellow (1995-1997)
SNEC accepted its first overseas fellow, Dr Marc Lawrence Weitzman. He had completed his residency and served three years in Mt Sinai Hospital in New York. Dr Weitzman did a six-month overseas fellowship in vitreo-retina during his attachment in SNEC. He then spent three months in China teaching general ophthalmology before returning to the US to take up another fellowship in glaucoma.
The second doctor from overseas to be attached for six-month attachment in SNEC was Dr Grace Gray Mugume from Mbuya Hospital in Kampala, Uganda. Sponsored by the Uganda government, Dr Mugume, a general ophthalmologist, started his fellowship programme in micro-surgery in July, 1993. Upon completion of his fellowship programme, Dr Mugume resumed his duties as a general ophthalmologist in Mbuya Hospital with the experience gained here.
Dr Zhao Shao-Zhen, a senior resident from the International Intraocular Implant Training Centre in Tianjin, China, became SNEC’s third overseas fellow when she accepted a one-year fellowship programme. Besides upgrading her knowledge in intra-ocular implant surgery and other eye surgical procedures, she also participated in excimer and glaucoma clinical research projects. She completed her fellowship in May 1995.
Dr Paul Foster, from the United Kingdom, was a glaucoma fellow at SNEC from 1995 to 1997. During his first two years he was attached to the glaucoma service as a research registrar, where he participated in the multicenter randomised trials on 5-FU for filtration surgery. During his third year he took an active role in our Tanjong Pagar Community Survey for glaucoma in the elderly. He also took time off to observe the prevalence of glaucoma in Mongolia.
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19 Fostering a culture of academic medicine Academic medicine demands a spirit of inquiry, bringing questions from bedside to the bench and back to the bedside for the right solutions. It is about harnessing the synergies of education and research to innovate and meet the future needs of patients. In March 2012, SNEC launched the Ophthalmology and Visual Sciences Academic Clinical Programme with our academic medicine partner, Duke-NUS. Under a culture of innovation, our doctors and staff on the ground are continuously involved in addressing clinical problems and identifying gaps that exist in a systematic way in search of the right solution that is evidencebased. Realising 15 to 20 years ago that myopia was going to be a huge problem in Singapore, a series of clinical studies and trials were pursued to ďŹ nd a solution which eventually led to the ďŹ nding that low dose atropine could reduce myopia progression by up to 60 per cent. The eye drop, MyopineTM is now in production to serve our patients. 47
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Going international: SNEC AHP training programme The need for well trained and well qualified allied health professionals (AHPs) has not been more acutely felt as the ageing population and ever increasing eye care demand place severe pressure on the existing staff force. In May 2014, SNEC partnered Duke-NUS Graduate Medical School Singapore to develop its first formal training programme offering different levels of training and certification for AHPs such as ophthalmic technicians and ophthalmic nurses. The programme has further been accredited by the international division of the US-based Joint Commission on Allied Health Personnel for Ophthalmology (IJCAHPO), making SNEC the first institution in Southeast Asia to receive the recognition. Participants who complete the programme will receive course certificates endorsed by the three organisations — IJCAHPO, SNEC and Duke-NUS. With the certification programme in place, the SNEC is poised to become a regional training and examination centre for IJCAHPO certificate programmes and hopes to fulfil its role as the regional training hub for ophthalmic staff at all levels.
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11th NATIONAL
eye care week
6-14 November 2010
6 Nov 2010, Sat FREE EYE SCREENING |
6 November 2010
TO REGISTER, CALL HOTLINE 6723 3878* OR VISIT www.snec.com.sg. Hotline operating hours: 25 Oct - 29 Oct, 9 am – 6 pm daily * Participation is on a first-come-first-served basis. Available by pre-registration only.
PUBLIC TALKS |
Singapore National Eye Centre (Balestier Branch) 363 Balestier Road, #02-00 ParkwayHealth Day Surgery and Medical Centre Singapore 329784 (Opposite Shaw Plaza)
6 November 2010, Saturday 9 am - 4 pm
Free Eye Screening Limited to the first 700 participants aged 45 years and above
Tan Tock Seng Hospital (Eye Centre) 11 Jalan Tan Tock Seng Level 1 Singapore 308433 (Opposite Foodcourt)
6 November 2010, Saturday 8.30 am - 11.30 am
Free Eye Screening Limited to the first 200 participants aged 45 years and above For free screening at Tan Tock Seng Hospital, call 6357 7648 / 6357 8533 or email eye@ttsh.com.sg to register
National University Hospital (Eye Clinic) 5 Lower Kent Ridge Road Kent Ridge Wing, Singapore 119074
6 November 2010, Saturday 9 am - 12 pm
Free Eye Screening Limited to the first 150 participants aged 45 years and above
Khoo Teck Puat Hospital 90 Yishun Central Singapore 768828 Clinic C 42, Tower C, Level 4
6 November 2010, Saturday 9 am - 12 pm
Free Eye Screening Limited to the first 120 participants aged 45 years and above Eye Care Talks from 9 am - 11 am
Jurong Medical Centre (Eye Clinic Level 3) 60 Jurong West Central 3 Singapore 648346 (next to Jurong West Community Library)
6 November 2010, Saturday 9 am - 12 pm
Free Eye Screening Limited to the first 100 participants aged 45 years and above
6-12 Nov 2010
6 November 2010
On-site registration on a first-come-first-served basis. Admission is free. Taking Care of the Ageing Eye
English
6 November 2010, Saturday, 9 am
Khoo Teck Puat Hospital, Auditorium
Glaucoma: The silent thief of sight
Mandarin
6 November 2010, Saturday, 9 am
Khoo Teck Puat Hospital, Learning Centre, Training Room 2
Diabetes and the Eye
English
6 November 2010, Saturday, 10 am
Khoo Teck Puat Hospital, Auditorium
What is Age-related Macular Degeneration?
Mandarin
6 November 2010, Saturday, 10 am
Khoo Teck Puat Hospital, Learning Centre, Training Room 2
Taking Care of the Ageing Eye
Mandarin
6 November 2010, Saturday, 11 am
Khoo Teck Puat Hospital, Auditorium
Taking Care of the Ageing Eye
Tamil
6 November 2010, Saturday, 11 am
Khoo Teck Puat Hospital, Learning Centre, Seminar Room 1
Taking Care of the Ageing Eye
English
6 November 2010, Saturday, 9 am
Jurong Medical Centre, Level 2
Taking Care of the Ageing Eye
Mandarin
6 November 2010, Saturday, 10 am
Jurong Medical Centre, Level 2
PUBLIC TALKS |
11-12 November 2010
TO REGISTER, VISIT www.snec.com.sg | EMAIL feedback@snec.com.sg | SMS name, date of talk and mobile no. to 9115 2672* * Admission is free and on a first-come-first-served basis. Available by pre-registration only. Refreshments from 6.30pm - 7pm. Age-Related Macular Degeneration (AMD) & Cataract
Mandarin
11 November 2010, Thursday, 6.30 pm - 8.30 pm
English
12 November 2010, Friday, 6.30 pm - 8.30 pm
Singapore National Eye Centre Auditorium, Level 4 11 Third Hospital Avenue, Singapore 168751 (Opp Outram Road)
HEALTHY EYES, HEALTHY LIFE EXHIBITION organised by Singapore National Eye Centre Marine Parade Public Library | 25 October - 18 November 2010
14 Nov 2010, Sun
In Conjunction With
WORLD DIABETES DAY World Diabetes Day 2010
Jointly organised by Diabetic Society of Singapore and Singapore National Eye Centre
FREE EYE SCREENING | 14 November 2010 TO REGISTER, CALL HOTLINE 6723 3880* OR VISIT www.snec.com.sg. Hotline operating hours: 25 Oct - 29 Oct, 9 am – 6 pm daily * Participation is on a first-come-first-served basis. Priority may be given to those with Diabetes. Available by pre-registration only.
venue
• FREE EYE SCREENING by Singapore National Eye Centre (SNEC), 9 am - 4 pm Limited to the first 800 participants aged 45 years and above. Priority will be given to those with Diabetes.
The Grassroots’ Club 190 Ang Mo Kio Avenue 8 Singapore 568046 (beside Yio Chu Kang MRT Station)
• FREE BLOOD PRESSURE & BODY MASS INDEX CHECKS by Diabetic Society of Singapore (DSS), 9 am - 4 pm • TALK ON COMMON EYE CONDITIONS such as cataract and diabetic retinopathy
guest of honour
• TALK ON DIABETES and its complication, management and diet
Mr. Masagos Zulkifli bin Masagos Mohamad Senior Parliamentary Secretary Ministry of Education and Ministry of Home Affairs
LivEnabled@the Park
• Learn more ABOUT INSULIN AND HEART • FOOT SCREENING
14 November 2010, Bishan Active Park
The event aims to raise public awareness of the challenges faced by the elderly and persons with disabilities. Come visit the SNEC interactive station and other booths at the event and learn about the challenges faced by the visually-impaired. Programme presented in collaboration with Singapore Association of the Visually Handicapped (SAVH). Visit www.livenabled.sg for more information. Jointly organised by
Supported by
Participating Organisations
Sponsors
Venue Sponsor
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For your eyes only As the designated national eye centre within Singapore’s public healthcare network, the SNEC has the responsibility to increase awareness of and promote eye health to the general public so that more will take better care of their eyes and protect their vision. Since 2000, the SNEC has helmed the National Eye Care Day, an annual community event rallying the support of eye departments of all hospitals in Singapore in its organisation. The general public can sign up for eye screenings and learn about eye care through interactive displays, poster exhibitions, video screenings, talks, quizzes and games at the event. In addition, SNEC also brings eye care into the community by working with community centres and grassroots organisations to conduct community eye screenings for common eye conditions such as cataracts and diabetic retinopathy that affect the elderly. SNEC has also facilitated the formation of several patient support groups such as the Glaucoma Support Group and the Retinitis Pigmentosa Support Group, both aimed at encouraging communication, shared experiences and self-help among sufferers of these debilitating eye conditions and their caregivers. 49
THROUGH THE LENS
SNEC’s New Mobile App Achieves Gold Singapore National Eye Centre (SNEC) clinched a Gold Award at the Asian Hospital Management Awards 2013 for the MyEyeDrops mobile application in the ‘Marketing, PR or Promotional Project’ category. The Asian Hospital Management Award recognises and honours hospitals in Asia that implement best hospital practices. This year, 300 entries from 78 hospitals entered for the awards in various categories. The MyEyeDrops app, launched in February 2013, helps glaucoma patients track their medication. It also allows users to set up medication lists and appointment reminders for different people, a convenient feature for those who are taking care of more than one patient. Video clips are also included to educate users on proper eye care and common eye conditions.
Mr Lee Kai Yin (right), SNEC Chief Projects Officer, receiving the award at the award ceremony in Bangkok
MyEyeDrops & MyEyeMatters Apps
SNEC Mobile App Team Front row (from left): Lai Hwei Ching, Belinda Toh, Margaret Tan, Dr Jocelyn Chua, Rosalie Lim, Wendy Wong, Tang Jia Yng, Cindy Tan, Oh Chin Guan (TechStudio) Back row (from left): Dr Daniel Su, Lee Kai Yin, Sylvester Lee (TechStudio) Not in photo: Ang Cheng Hian, Chiang Fi Li, Ngo Lay Harn, Priscilla Lim
An informational brochure on SNEC mobile apps
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Enabling patient care, one app at a time
Leveraging on mobile technology, SNEC is on the constant lookout for opportunities to meet patients’ needs. In February 2013, SNEC launched MyEyeDrops, a mobile app that reminds glaucoma patients to apply eye drops and medication according to the prescribed regime, with an accompanying tagline: Put the right drops in your eyes, at the right time! Regular compliance with the use of eye drops in controlling eye pressure is critical to prevent deterioration of the glaucoma condition but over 70 per cent of patients tend to miss their medications. With MyEyeDrops, forgetting to apply eye drops will be a thing of the past. Besides providing pre-set reminders, the app, which won an award in the Asian Hospital Management Awards in 2013, offers other useful features such as a calendar of educational eye
events and a medical diary for patients to document their medical history and drug allergies. That same year, SNEC also unveiled MyEyeMatters, an app that provides comprehensive information on various eye conditions and symptoms, as well as useful eye care tips. Through the app, patients and their caregivers can now better understand their eye conditions, why they are receiving certain procedures and medications, and how to take care of their eyes after an operation. Another app in that series, MyEyeGym — a stimulating and interactive eye exercise app with creative animations and cartoons — was also launched to encourage people with squints (strabismus) to do their eye exercises daily to achieve better control of certain type of squints.
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Highlight
Early detection is better than cure One of the holy grails in the healthcare sector is how to harness telemedicine, that is, to deliver healthcare information, data and services remotely using information technology (IT). In 2012, the SNEC partnered with Tan Tock Seng Hospital to pilot the Singapore Integrated Diabetic Retinopathy Programme (SiDRP) which was funded by the Ministry of Health that allows general practitioners, nurses and even opticians to capture eye images of diabetic patients as part of an annual eye screening process. Using a standardised protocol, retina images are sent via an IT system to be graded by trained technicians thus saving the time and resource of eye
specialists who hitherto had to juggle this task amidst their busy clinical and surgical schedules. The trained technicians/graders will now read the retinal images and recommend further investigation by an ophthalmologist, if the images were found to be abnormal. Diabetic retinopathy, a disorder of the blood vessels in the retina of diabetic patients, affects one in three patients with diabetes. The SiDRP facilitates the early detection of the condition, enabling early intervention and the prevention of vision loss. It has also eliminated inefficiencies in the screening process and delivered improved productivity and cost savings to the healthcare system.
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Highlight
24 THROUGH THE LENS
Designed with the Elderly in Mind With more than half of the patients in the Singapore National Eye Centre (SNEC) being elderly, our facilities and services have been improved for patients’ safety, ease of access, and comfort. Since 2013, we have been working on key initiatives to build a sustainable age-friendly environment and promote practices that allow elderly patients to navigate and use our healthcare services in a more efficient and effective manner.
ACCESSIBILITY & COMFORT A clearly marked reception area fitted with low-height counter at the lobby to allow wheelchair users smooth access and communication with staff.
SAFE ENVIRONMENT An extended driveway specially caters to more cars and longer duration for elderly patients to board or disembark from vehicles.
IMPROVED PATIENT FLOW Rearrangement of key services in close proximity to reduce walking distance (from 163 to 126 metres), save effort and time for patients.
SAFE WALKING Handrails are fitted along both sides of walking areas and at shuttle bus point for safe movement.
EASY READING A magnifying glass at the information desk to aid elderly or lowvision patients to read the fine-print.
CLEAR SIGNS Signs in clinics and lift lobbies are in large, bold fonts and accompanied by nonreflective raised letters and pictograms to help elderly patients with poor eyesight. Key signage and directories are in English, Chinese, Malay and Tamil.
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SNEC Receives SingHealth Age-Friendly Award Singapore National Eye Centre (SNEC) was recognised by SingHealth for its sustainable age-friendly initiatives for patients in an award ceremony held on 19 November 2013.
SNEC team with Professor Ivy Ng, Group CEO, SingHealth (centre) at the award presentation ceremony
Elderly patients suffer from physical weakness and reduced visual, hearing, and cognitive acuity, besides their medical conditions. Age-friendly features are hence essential in ensuring safety and creating a pleasant patient care experience for the elderly. At SNEC, some of the key services commonly needed by the patients have been identified and arranged in close proximity so that patients can get from one point of service to another to reduce walking distance, effort and time. Other elderly-friendly features in the centre include handrails along walking areas, non-slip flooring, distinctly-coloured signs with large font, hot beverage option for the elderly in waiting areas and wheelchair-friendly counselling rooms.
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Age-friendly environment With the increasing volume of elderly patients accessing the healthcare system, who usually suffer from physical weakness as well as reduced visual, hearing, and cognitive abilities, agefriendly features have become a necessity at many clinics and hospitals to ensure a safe and pleasant experience for seniors. At SNEC, some key services commonly used by the patients were identified and rearranged in close proximity to enable patients to get from one point of service to another within a shorter distance (actual distance travelled measured and reduced from 163 metres to 126 meters) — and with less effort. Other elderly-friendly features in the centre include handrails along walking areas, non-slip flooring, coloured signs with large font, hot beverage options for the elderly in waiting areas and wheelchair-friendly counselling rooms. A magnifying glass is also thoughtfully placed at the information desk to aid the elderly or low-vision patients in reading the fine print. For such efforts, the SNEC was recognised by SingHealth for its sustainable age-friendly initiatives for patients in November 2013.
The Sunday Times 19 April 2015
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On the frontlines of philanthropy
On the special occasion of the centre’s 25th anniversary, the SNEC has embarked on an ambitious effort to raise $25 million over five years to support needy patients, community outreach and research activities through the establishment of the Vision Fund. The new fundraising initiative will support SNEC’s various research areas such as health sciences research, medical technology development, retinal diseases and myopia. For example, with the additional funding, SNEC will be able to further its research on the effects of atropine in reducing the progression on myopia over the years.
The Vision Fund can also be used to help needy patients, raise public awareness of eye care and in training grants that will support subspecialists identified to further specialise in fields such as paediatric retina and ophthalmic oncology. The Vision Fund is also expected to instil a culture of philanthropy at SNEC. Many clinics and frontline counter staff will be trained and equipped with tools of engagement to empower them. They will be part of a team working on the frontlines of philanthropy approaching potential donors and creating opportunities for them to contribute towards the meaningful causes.
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From Vision to Reality Professor Wong Tien Yin Medical Director, SNEC
The 25 highlights of this book have vividly traced the development of the SNEC, from what was at that time a bold, “risky” idea to an internationally-leading institution that it is today. We remain conscious that we cannot rest on our laurels; instead, we must continue to move forward, with our patients at the heart of all we do. Our key guiding principle must be to provide ‘best-in-class’ clinical service, supported by ‘best-in-class’ innovative research and ‘best-in-class’ training and education. What does ‘best-in-class’ mean? What seems to be ‘best’ is seldom what is optimal and appropriate. For example, what may be touted as ‘best’ in the United States or in the private sector care may mean the more expensive treatment or surgery that provides either a cosmetic or incremental improvement in clinical outcomes. As the national eye centre in Singapore, we will need to focus on what is best for all Singaporeans, based on evidence and costeffectiveness, rather than simply imitate what is done elsewhere. How we do get there? Will we continue to grow in size so we can continue to keep up with increasing patient volume and demand? Perhaps not. Our bold vision is a SNEC that is lean, innovative and efficient. In fact, patients should not have to travel from all over
Singapore to receive treatment at SNEC. If we are truly successful in our mission – to prevent vision loss in the population – the needs of most patients should be attended to in the community and in primary care settings; patients would only need to come to SNEC for surgery or specialist procedures and quickly return to their primary care. Preventive care is our real future, not a sprawling, overloaded service that handles a high caseload. Thus, we must aim to design new, perhaps disruptive models of care, ensuring that they are safe and with better outcomes, while continuing to make SNEC services accessible if needed. SNEC’s goal should not be to compete on metrics such as the size of our institution or the number of operations performed; we must aim to keep the population level of eye health high and vision loss low. Improving eye health is intricately interwoven with improving the general health of our population. There is good evidence that people with vision problems are more likely to be depressed and suffer from higher mortality in general. It is my vision that we will reach the point where vision loss is no longer a major cause of morbidity in Singapore. To do this, we will develop initiatives such as telemedicine, home monitoring, patient education and
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screening programmes. Through coordinating such efforts, SNEC can lead the community in picking up early disease and reducing the number of major interventions required. In fact, such activities are very much in line with the goals of our development of Academic Medicine, and as part of the SingHealth Duke-NUS Academic Medicine Centre. It also aligns with the Ministry of Health’s (MOH) Healthcare 2020 Masterplan to tackle the problems of Singapore’s changing demographics. As part of our goal to be ‘best-in-class’, we will also focus on diseases that are relevant to our patient population. One good example is angle closure glaucoma, which is more prevalent in Asian populations. If we look at our publications in this field over the last ten years, SNEC and the SERI are top ranked, as are our individual researchers such as Professor Aung Tin, Executive Director of SERI. Apart from putting Singapore on the map, SNEC must become the Moorfields Eye Hospital and the Wilmer Eye Institute of the East. In fact, we have the potential to be more. Our solutions for Asian-centric eye disease will not only help Singapore’s 5.5 million population but make a direct impact on the 4.4 billion people living in Asia. Finally, I would like to take this opportunity to
personally thank the people who have mentored me along the way. I am indebted to Professor Arthur Lim, the father of SNEC, but I also have had the benefit of being nurtured and supported by the late Professor Chew Sek Jin, and SNEC’s Medical Directors Associate Professor Vivian Balakrishnan, Professor Ang Chong Lye and Professor Donald Tan. I have benefited from the advice and guidance from many others, including Professor Tan Chorh Chuan, Professor John Wong from the National University of Singapore, Professor Alfred Sommer and Professor James Tielsch from Johns Hopkins University, Professor Hugh Taylor from the University of Melbourne, and Professors Ronald and Barbara Klein from the University of Wisconsin-Madison. I would also like to thank our SNEC pioneers. I am grateful to them for being teachers and senior consultants, for training me and many of us at SNEC, and for continuing to contribute alongside us today: Professor Chee Soon Phaik, Adjunct Associate Professor Seah Lay Leng, and Doctors Choo Chai Teck, Peter Tseng, Ronald Yeoh, Yvonne Ling, among many others. The SNEC of tomorrow at 50 years will be and must be different from the SNEC of today at 25 years. Our vision, however, will remain the same.
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Acknowledgements SNEC would like to express its appreciation to Singapore Press Holdings and SingHealth for permission to reproduce the news articles in this publication.
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